<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article  PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "http://dtd.nlm.nih.gov/publishing/3.0/journalpublishing3.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="3.0" xml:lang="en" article-type="research article"><front><journal-meta><journal-id journal-id-type="publisher-id">AiM</journal-id><journal-title-group><journal-title>Advances in Microbiology</journal-title></journal-title-group><issn pub-type="epub">2165-3402</issn><publisher><publisher-name>Scientific Research Publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.4236/aim.2012.24066</article-id><article-id pub-id-type="publisher-id">AiM-25866</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Biomedical&amp;Life Sciences</subject></subj-group></article-categories><title-group><article-title>
 
 
  Stress-Induced Dispersal of &lt;i&gt;Staphylococcus epidermidis&lt;/i&gt; Biofilm Is Due to Compositional Changes in Its Biofilm Matrix
 
</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>harlène</surname><given-names>Coulon</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Irina</surname><given-names>Sadovskaya</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Philippe</surname><given-names>Lencel</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Saïd</surname><given-names>Jabbouri</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Jeffrey</surname><given-names>B. Kaplan</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Sigrid</surname><given-names>Flahaut</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib></contrib-group><aff id="aff3"><addr-line>Department of Oral Biology, New Jersey Dental School, Newark, USA</addr-line></aff><aff id="aff4"><addr-line>Service de Microbiologie Appliquée, Université Libre de Bruxelles (ULB), c/o Institut de Recherches Microbiologiques Jean-Marie Wiame (IRMW), Bruxelles, Belgium</addr-line></aff><aff id="aff1"><addr-line>UMT, Université du Littoral-C?te d’Opale, Boulogne-Sur-Mer, France</addr-line></aff><aff id="aff2"><addr-line>Institut de Recherche pour le Développement, Maadi, Egypt</addr-line></aff><author-notes><corresp id="cor1">* E-mail:<email>coulon0charlene@gmail.com(HC)</email>;</corresp></author-notes><pub-date pub-type="epub"><day>20</day><month>12</month><year>2012</year></pub-date><volume>02</volume><issue>04</issue><fpage>518</fpage><lpage>522</lpage><history><date date-type="received"><day>October</day>	<month>5,</month>	<year>2012</year></date><date date-type="rev-recd"><day>November</day>	<month>3,</month>	<year>2012</year>	</date><date date-type="accepted"><day>November</day>	<month>12,</month>	<year>2012</year></date></history><permissions><copyright-statement>&#169; Copyright  2014 by authors and Scientific Research Publishing Inc. </copyright-statement><copyright-year>2014</copyright-year><license><license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p></license></permissions><abstract><p>
 
 
  Biofilm formation is an important virulence factor of 
  Staphylococcus epidermidis. However, little is known about the mechanisms of staphylococcal biofilm dispersal. In the present study, we investigated biofilm dispersal of the model biofilm-forming strain 
  S. epidermidis RP62A under oligotrophic stress conditions. We found that oligotrophic stress led to rapid dispersal of pre-formed biofilms and concomitant changes in the composition of the extracellular matrix, including a decrease in poly-
  N-acetylglucosamine polysaccharide and an increase in proteins. Our results suggest that modifications in biofilm integrity caused by compositional changes in the biofilm matrix can induce biofilm dispersal.
 
</p></abstract><kwd-group><kwd>&lt;i&gt;Staphylococcus epidermidis&lt;/i&gt;; Biofilm Composition; Detachment; Nutrient Limitation</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>1. Introduction</title><p>Staphylococcus epidermidis is a major cause of indwelling medical device infections [<xref ref-type="bibr" rid="scirp.25866-ref1">1</xref>]. The persistence of such infections is due to the ability of infecting bacteria to adhere to the surface of artificial devices and to form multilayered cell clusters known as biofilms [<xref ref-type="bibr" rid="scirp.25866-ref2">2</xref>]. Adherent or sessile bacteria, embedded in a polymeric biofilm matrix, are more resistant to conventional antimicrobial agents and host defenses than free-living planktonic cells. Biofilm cells are capable of persisting in the presence of antimicrobials at concentrations that are up to 1000-fold higher than those necessary to eradicate a planktonic population [<xref ref-type="bibr" rid="scirp.25866-ref3">3</xref>]. Biofilm-associated bacteria are difficult to eradicate, and removal of the infected device is often required for an efficient treatment of biofilm infection.</p><p>Several studies have investigated the composition of the S. epidermidis biofilm matrix, which was found to contain poly-β-(1,6)-N-acetylglucosamine (Polysaccharide Intercellular Adhesin, PIA) polysaccharide, proteins, and teichoic acids [4,5]. PIA, which mediates cell-to-cell adhesion, is considered to be the major functional component in S. epidermidis biofilms [2,6]. Recent data suggest that S. epidermidis does not produce enzymes that degrade PIA [7,8]. Some S. epidermidis strains are able to produce biofilms not containing PIA [<xref ref-type="bibr" rid="scirp.25866-ref9">9</xref>]. However these biofilms are less adherent than PIA-dependent biofilms (unpublished data). PIA-independent biofilm formation was shown to rely on the expression of the accumulation-associated protein (AAP) [<xref ref-type="bibr" rid="scirp.25866-ref10">10</xref>].</p><p>The detachment and dispersal of bacterial cells from biofilms is a strategy by which bacteria colonize new niches when space and nutrients become limiting for growth [<xref ref-type="bibr" rid="scirp.25866-ref11">11</xref>]. Nutrient starvation has been shown to induce detachment of biofilms produced by Pseudomonas aeruginosa [<xref ref-type="bibr" rid="scirp.25866-ref12">12</xref>], P. fluorescens [<xref ref-type="bibr" rid="scirp.25866-ref13">13</xref>], P. putida [<xref ref-type="bibr" rid="scirp.25866-ref14">14</xref>] and Aeromonas hydrophila [<xref ref-type="bibr" rid="scirp.25866-ref15">15</xref>]. Glucose depletion can disperse a Staphylococcus aureus biofilm [<xref ref-type="bibr" rid="scirp.25866-ref16">16</xref>]. J&#228;ger et al. [<xref ref-type="bibr" rid="scirp.25866-ref17">17</xref>] showed that S. epidermidis biofilms undergo a gradual disintegration over a period of seven-day when challenged with low-glucose medium or phosphate buffered saline. However, none of these studies explain the mechanism of starvation-induced biofilm detachment.</p><p>In the present study, we investigated biofilm detachment and the evolution of the biofilm matrix composition under oligotrophic stress conditions in the model strain S. epidermidis RP62A. We observed rapid biofilm dispersal and significant changes in the relative amounts of PIA and proteins in the biofilm matrix under nutrient starvetion conditions, suggesting that compositional changes in the biofilm matrix can result in biofilm dispersal.</p></sec><sec id="s2"><title>2. Material and Methods</title><sec id="s2_1"><title>2.1. Bacterial Strains and Media</title><p>S. epidermidis RP62A was kindly provided by Prof. Gerald Pier (Harvard Medical School, Boston, MA). Bacteria were stored at –20˚C in 15% (v/v) glycerol.</p><p>S. epidermidis RP62A was cultivated in two different media: 1) an oligotrophic carbon-starved medium (OM) developed in our laboratory: 50 mL mineral base (2 g&#183;L<sup>–</sup><sup>1</sup> glutamic acid, 0.2 g&#183;L<sup>–</sup><sup>1</sup> MgSO<sub>4</sub>, 0.01 g&#183;L<sup>–</sup><sup>1</sup> NaCl, 0.5 mg&#183;L<sup>–</sup><sup>1</sup> FeCl<sub>2</sub>, 1 mg&#183;L<sup>–</sup><sup>1</sup> MnSO<sub>4</sub>), 50 mL yeast extract (2 g&#183;L<sup>–</sup><sup>1</sup>), 62.5 mL acid-hydrolyzed casein (20 g&#183;L<sup>–</sup><sup>1</sup>), 5 mL vitamin B1 (thiamine; 0.1 mg&#183;mL<sup>–</sup><sup>1</sup>), and 832.5 mL phosphate buffer (100 mM, pH 7); or 2) Tryptic Soy broth (TSB; Becton Dickinson, Le Pont de Claix, France).</p></sec><sec id="s2_2"><title>2.2. Growth and Survival Studies</title><p>Bacteria were grown in TSB, supplemented with 1% glucose (w/v) for 18 h at 37˚C with shaking. Cultures were then diluted at 1% in fresh TSB or OM medium. The cultures were incubated at 37˚C with shaking and the absorbance was measured after increasing amounts of time in a Heλios β spectrophotometer (Fischer) set to 600 nm.</p><p>To study bacterial survival, overnight cultures were diluted in fresh TSB to an A<sub>600</sub> of 1. Ten mL of this suspension was harvested by centrifugation at 4000 &#215; g. The pellet was suspended in 50 mL of fresh medium and incubated at 37˚C with shaking. At 0, 3 and 24 h, 500 μL of the cell suspension was removed and then serially diluted at 1:10 into 0.9% NaCl (w/v). The 10<sup>–</sup><sup>5</sup>, 10<sup>–</sup><sup>6</sup>, 10<sup>–</sup><sup>7</sup> dilutions were spread in duplicate onto Tryptic Soy agar plates using 5 mm-diameter glass beads. The plates were incubated for 24 h at 37˚C, and CFUs were enumerated to calculate the percentage of survival.</p></sec><sec id="s2_3"><title>2.3. Biofilm Quantification</title><p>To quantify biofilms, the methods of Christensen et al. [<xref ref-type="bibr" rid="scirp.25866-ref18">18</xref>] with some modifications were used. Briefly, an overnight planktonic culture was diluted 1:100 into fresh TSB medium containing 1% glucose. Wells of polystyrene tissue culture-treated 96-well microtiter plates (Nunclon, Nunc) were filled with 200 μL aliquots of inoculum, and the plate was incubated for 24 h at 37˚C with gentle shaking for biofilm formation. After this incubation step, TSB was replaced with fresh TSB or OM medium. After increasing amounts of time, the biofilms were washed twice with 200 μL of 0.9% NaCl and dried at 55˚C for 45 min. The adherent cells were stained with 200 μL of 0.5% safranin for 10 min and rinsed again with 0.9% NaCl. One hundred &#181;L of 0.9% NaCl per well was added, and the absorbance was measured using a μQuant microtiter plate reader (Bio-Tek Instruments, Winooski, USA) set to 531 nm. For each experiment, background staining was corrected by subtracting the A<sub>531</sub> value of safranin bound to non-inoculated controls. Each experiment was performed at least three times.</p></sec><sec id="s2_4"><title>2.4. Quantification of PIA and Protein in the Biofilm Matrix</title><p>An overnight planktonic culture was diluted 1:100 into fresh TSB medium containing 1% glucose. Tissue-culture-treated Petri dishes (100-mm-diam; Greiner) were filled with 20 mL aliquots of inoculum, and the culture was incubated statically for 24 h at 37˚C.</p><p>For quantification of PIA and protein in the biofilm matrix TSB was removed and replaced by fresh TBS or OM medium. At 0, 3, 6 and 24 h, the supernatant was removed, and the biofilm was washed with 5 mL of 0.9% NaCl. The biofilm was completely removed from the plastic surface by gentle scraping in the presence of 25 ng/mL of the PIA-degrading enzyme dispersin B [<xref ref-type="bibr" rid="scirp.25866-ref19">19</xref>] in 5 mL of 0.9% NaCl. The biofilm was then homogenized and aliquots of the suspension were used for CFU enumeration. Cells were then removed from the remaining suspension by centrifugation (5000 &#215; g, 10 min, 4˚C), and the supernatant was assayed for protein using a BioRad colorimetric assay, and for aminosugars using a Morgan-Elson assay [<xref ref-type="bibr" rid="scirp.25866-ref20">20</xref>], with bovine serum albumin and GlcNAc as standards, respectively.</p><p>For studying PIA degradation during an oligotrophic stress, biofilm cells were treated immediately in the control experiment and in biofilm dispersal experiment after 3 h of incubation at 37˚C. The biofilm was completely removed from the plastic surface by gentle scraping, the culture was transferred into a plastic container, and sonicated on ice (IKASONIC sonicator; 50% amplitude, cycle 0.5, 3 times for 30 s; IKA Labortechnik, Staufen, Germany). Cells were removed by centrifugation and the supernatant clarified by additional centrifugation (10.000 g, 10 min, 4˚C). The extract was applied to a Sephadex G-50 column (1 &#215; 40 cm), eluted with acetic acid (1%). Aliquots of each 2 mL fraction were screened for aminosugars using a Morgan-Elson assay [<xref ref-type="bibr" rid="scirp.25866-ref20">20</xref>], and the corresponding elution profiles were compared.</p></sec></sec><sec id="s3"><title>3. Results and Discussion</title><sec id="s3_1"><title>3.1. Impact of Oligotrophic Stress on Growth of Staphylococcus epidermidis</title><p>Before we could evaluate the effect of oligotrophic conditions on biofilms, we established the composition of a low-carbon medium which does not induce bacterial growth but preserves 100% survival. We considered that these conditions resulting in impaired growth rate can be defined as an oligotrophic stress. Since S. epidermidis is polyauxotrophic, a mineral medium supplemented with minimal amount of yeast and casein extract (oligotrophic medium, OM) was tested. S. epidermidis RP62A grown for 24 h at 37˚C in OM showed only few cellular divisions, with maximum growth rate &#181; = 0.3, compared to &#181; = 1.46 in TSB (data not shown). To ensure that bacteria in OM medium were carbon-starved, we added glucose (0.5% w/v) at various times during the first 24 h of culture. In all cases, the bacterial growth started immediately (data not shown). To evaluate bacterial survival, we quantified the number of CFUs after 0, 3, 6 and 24 h in OM at 37˚C. The survival rates remained close to 100%. Based on these data, we concluded that bacterial cells in OM medium were stressed by nutrientstarvation, and we tested this effect on S. epidermidis biofilms.</p></sec><sec id="s3_2"><title>3.2. Biofilm Detachment by Nutritive Stress</title><p>In order to test the effect of nutritive stress on S. epidermidis RP62A biofilms, bacteria were grown in polystyrene 96-well microtiter plates. Once biofilm formed, TSB was replaced with fresh TSB or OM medium and cultures were incubated for 24 h at 373˚C. The evolution of biofilm was quantified colorimetrically at different incubation times. The results of this experiment clearly showed that the substitution of the rich medium with the oligotrophic one lead to a significant reduction of biofilm (<xref ref-type="fig" rid="fig1">Figure 1</xref>(a)), especially during the first 3 h of nutrient limitation. In the unchanged medium, the amount of biofilm remained stable (<xref ref-type="fig" rid="fig1">Figure 1</xref>(a)) indicating that the observed biofilm reduction was not due to turgor, turbulence or shock of replacing media. These results suggest that the nutritive stress caused by the OM medium induced the detachment of S. epidermidis RP62A cells from the biofilm.</p></sec><sec id="s3_3"><title>3.3. Evolution of Biofilm Matrix Composition under Conditions of Nutrient Stress</title><p>It is known that biofilm matrix of S. epidermidis RP62A contains a significant amount of a poly-β-(1,6)-N-acetylglucosamine polysaccharide (PIA) and proteins [5,6]. We measured the amount of aminosugars and proteins in the matrix of S. epidermidis RP62A biofilms subjected or not to oligotrophic stress. Biofilms were grown on the surfaces of tissue-culture-treated Petri dishes and subjected to nutritive stress as described above for the 96- wells microtiter plates. After increasing amounts of time, biofilm cells were detached, the matrix was homogenized by treatment with dispersin B, and amino-sugars and</p><p>proteins were quantified by colorimetric methods.</p><p>Since PIA is considered as the major aminosugar containing component of S. epidermidis RP62A biofilm matrix under these experimental conditions, and extracellular teichoic acid (EC TA) contains much smaller amount of GlcNAc [<xref ref-type="bibr" rid="scirp.25866-ref5">5</xref>], we estimated that quantity of aminosugars in biofilm matrix correlates with the quantity of PIA.</p><p>Following oligotrophic stress, the amount of aminosugar decreased over time while the amount of protein increased. The ratio of aminosugar to protein (<xref ref-type="fig" rid="fig1">Figure 1</xref>(b)) correlated with the amount of biofilm dispersal (<xref ref-type="fig" rid="fig1">Figure 1</xref>(a)). In the control without nutritive stress the amounts of aminosugar and protein increased, thus the ratio of aminosugar to protein remained stable over the</p><p>time (<xref ref-type="fig" rid="fig1">Figure 1</xref>(b)).</p><p>The observed changes in chemical composition of the S. epidermidis biofilm matrix under nutrient-limiting conditions are in agreement with previous studies on regulation of biofilm formation by S. epidermidis [<xref ref-type="bibr" rid="scirp.25866-ref17">17</xref>]. Activity of the alternative sigma factor σ<sup>B</sup>, the key inductor of genes to adapt to environmental stress, is important for PIA-dependent biofilm formation in S. epidermidis, and σ<sup>B</sup> mutants do not synthesize PIA, which results in decreased autoaggregation and biofilm formation [<xref ref-type="bibr" rid="scirp.25866-ref21">21</xref>]. It was previously shown that stability of S. epidermidis biofilms under glucose-limiting conditions depended on the activity of the alternative sigma factor σ<sup>B</sup> [<xref ref-type="bibr" rid="scirp.25866-ref17">17</xref>]. Dispersal of the biofilm during nutritive stress, therefore, could be related to regulation in the synthesis of PIA.</p><p>In an attempt to better understand the molecular mechanisms of the observed biofilm dispersal, we tested if PIA was degraded during the oligotrophic stress. We compared the chromatographic profiles of the extracellular extract before and after an oligotrophic stress on a Sephadex G-50 gel-filtration column, with the colorimetric screening of fractions for aminosugars. The two elution profiles were similar (<xref ref-type="fig" rid="fig2">Figure 2</xref>), indicating that molecular weight (MW) distribution of aminosugar-containing polymers did not change following the oligotrophic stress.</p><p>We therefore concluded that the observed biofilm dispersal during an oligotrophic stress was not due to a specific enzymatic degradation of PIA. These data are in agreement with previous studies [7,8] showing that the dispersal of S. epidermidis biofilm was not due to a synthesis of a PIA degrading enzyme.</p></sec></sec><sec id="s4"><title>4. Conclusion</title><p>In conclusion, our findings provide evidence that a decrease in the amount of aminosugar and increase in the amount of protein in the S. epidermidis biofilm matrix under nutritive stress conditions can lead to a lower cellto-cell adhesion and thus facilitate a release of bacterial cells into the environment. Understanding mechanisms of biofilm dispersal could lead to the development of clinically useful agents that promote biofilm detachment and thus contribute to a successful treatment of chronic biofilm-related infections.</p></sec><sec id="s5"><title>5. Acknowledgements</title><p>We are obliged to Dr. Thierry Grard (ULCO) for his supports and fruitful discussion and Prof. Pierre Hardouin (PMOI, ULCO) for his financial support.</p></sec><sec id="s6"><title>REFERENCES</title></sec><sec id="s7"><title>NOTES</title></sec></body><back><ref-list><title>References</title><ref id="scirp.25866-ref1"><label>1</label><mixed-citation publication-type="other" xlink:type="simple">F. Gotz, “Staphylococcus and Biofilms,” Molecular Microbiology, Vol. 43, 2002, pp. 1367-1378.  
doi:10.1046/j.1365-2958.2002.02827.x </mixed-citation></ref><ref id="scirp.25866-ref2"><label>2</label><mixed-citation publication-type="other" xlink:type="simple">D. Mack, A. P. Davies, L. G. Harris, H. Rohde, M. A. Horstkotte and J. K. M. Knobloch, “Microbial Interactions in Staphylococcus epidermidis Biofilms,” Analytical and Bioanalytical Chemistry, Vol. 387, No. 2, 2007, pp. 399-408. doi:10.1007/s00216-006-0745-2 </mixed-citation></ref><ref id="scirp.25866-ref3"><label>3</label><mixed-citation publication-type="other" xlink:type="simple">N. Cerca, S. Martins, G. B. Pier, R. Oliveira and J. Azeredoa, “The Relationship between Inhibition of Bacterial Adhesion to a Solid Surface by Sub-MICs of Antibiotics and Subsequent Development of a Biofilm,” Research in Microbiology, Vol. 156, 2005, pp. 650-655.  
doi:10.1016/j.resmic.2005.02.004 </mixed-citation></ref><ref id="scirp.25866-ref4"><label>4</label><mixed-citation publication-type="other" xlink:type="simple">I. Sadovskaya, P. Chaignon, G. Kogan, A. Chokr, E. Vinogradov and S. Jabbouri, “Carbohydrate-Containing Components of Biofilms Produced in Vitro by Some Staphylococcal Strains Related to Orthopaedic Prosthesis Infections,” FEMS Immunology and Medical Microbiology, Vol. 47, 2006, pp. 75-82.  
doi:10.1111/j.1574-695X.2006.00068.x </mixed-citation></ref><ref id="scirp.25866-ref5"><label>5</label><mixed-citation publication-type="other" xlink:type="simple">I. Sadovskaya, E. Vinogradov, S. Flahaut, G. Kogan and S. Jabbouri, “Extracellular Carbohydrate-Containing Polymers of a Model Biofilm-Producing Strain, Staphylococcus epidermidis RP62A,” Infection and Immunity, Vol. 73, No. 5, 2005, pp. 3007-3017.  
doi:10.1128/IAI.73.5.3007-3017.2005 </mixed-citation></ref><ref id="scirp.25866-ref6"><label>6</label><mixed-citation publication-type="other" xlink:type="simple">D. Mack, W. Fischer, A. Krokotsch, K. Leopold, R. Hartmann, H. Egge and R. Laufs, “The Intercellular Adhesin Involved in Biofilm Accumulation of Staphylococcus epidermidis Is a Linear Beta-1,6-Linked Glucosaminoglycan: Purification and Structural Analysis,” Journal of Bacteriology, Vol. 178, No. 1, 1996, pp. 175-183.</mixed-citation></ref><ref id="scirp.25866-ref7"><label>7</label><mixed-citation publication-type="other" xlink:type="simple">M. Otto, “Staphylococcal Biofilms,” Current Topics in Microbiology and Immunology, Vol. 322, 2008, pp. 207-228.</mixed-citation></ref><ref id="scirp.25866-ref8"><label>8</label><mixed-citation publication-type="other" xlink:type="simple">R. Wang, B. A. Khan, G. Y. Cheung, T. H. Bach, M. Jameson-Lee, K. Kong, S. Y. Queck and M. Otto, “Staphylococcus epidermidis Surfactant Peptides Promote Biofilm Maturation and Dissemination of Biofilm-Associated Infection in Mice,” Journal of Clinical Investigation, Vol. 121, No. 1, 2011, pp. 238-248. doi:10.1172/JCI 42520.</mixed-citation></ref><ref id="scirp.25866-ref9"><label>9</label><mixed-citation publication-type="other" xlink:type="simple">G. Kogan, I. Sadovskaya, P. Chaignon, A. Chokr and S. Jabbouri, “Biofilms of Clinical Strains of Staphylococcus that Do Not Contain Polysaccharide Intercellular Adhesin,” FEMS Microbiology Letters, Vol. 255, 2006, pp. 11-16. doi:10.1111/j.1574-6968.2005.00043.x </mixed-citation></ref><ref id="scirp.25866-ref10"><label>10</label><mixed-citation publication-type="other" xlink:type="simple">H. Rohde, C. Burdelski, K. Bartscht, M. Hussain, F. Buck, M. A. Horstkotte, J. K.-M. Knobloch, C. Heilmann, M. Herrmann and D. Mack, “Induction of Staphylococcus epidermidis Biofilm Formation via Proteolytic Processing of the Accumulation-Associated Protein by Staphylococcal and Host Proteases,” Molecular Microbiology, Vol. 55, 2005, pp. 1883-1895.  
doi:10.1111/j.1365-2958.2005.04515.x </mixed-citation></ref><ref id="scirp.25866-ref11"><label>11</label><mixed-citation publication-type="other" xlink:type="simple">J. B. Kaplan, “Biofilm Dispersal: Mechanisms, Clinical Implications, and Potential Therapeutic Uses,” Journal of Dental Research, Vol. 89, No. 3, 2010, pp. 205-218.  
doi:10.1177/0022034509359403 </mixed-citation></ref><ref id="scirp.25866-ref12"><label>12</label><mixed-citation publication-type="other" xlink:type="simple">S. M. Hunt, E. M. Werner, B. Huang, M. A. Hamilton and P. S. Stewart, “Hypothesis for the Role of Nutrient Starvation in Biofilm Detachment,” Applied and Environmental Microbiology, Vol. 70, No. 12, 2004, pp. 7418-7425. doi:10.1128/AEM.70.12.7418-7425.2004 </mixed-citation></ref><ref id="scirp.25866-ref13"><label>13</label><mixed-citation publication-type="other" xlink:type="simple">P. J. Delaquis, D. E. Caldwell, J. R. Lawrence and A. R. McCurdy, “Detachment of Pseudomonas fluorescens from Biofilms on Glass Surfaces in Response to Nutrient Stress,” Microbial Ecology, Vol. 18, 1989, pp. 199-210.  
doi:10.1007/BF02075808 </mixed-citation></ref><ref id="scirp.25866-ref14"><label>14</label><mixed-citation publication-type="other" xlink:type="simple">M. Gjermansen, M. Nilsson, L. Yang and T. Tolker-Nielsen, “Characterization of Starvation-Induced Dispersion in Pseudomonas putida Biofilms: Genetic Elements and Molecular Mechanisms,” Molecular Microbiology, Vol. 75, 2010, pp. 815-826.  
doi:10.1111/j.1365-2958.2009.06793.x </mixed-citation></ref><ref id="scirp.25866-ref15"><label>15</label><mixed-citation publication-type="other" xlink:type="simple">L. K. Sawyer and S. W. Hermanowicz, “Detachment of Biofilm Bacteria Due to Variations in Nutrient Supply,” Water Science and Technology, Vol. 37, No.4, 1998, pp. 211-214. doi:10.1016/S0273-1223(98)00108-5 </mixed-citation></ref><ref id="scirp.25866-ref16"><label>16</label><mixed-citation publication-type="other" xlink:type="simple">B. R. Boles and A. R. Horswill, “Agr-Mediated Dispersal of Staphylococcus aureus Biofilms,” PLoS Pathogens, Vol. 4, 2008, Article ID: e1000052.  
doi:10.1371/journal.ppat.1000052 </mixed-citation></ref><ref id="scirp.25866-ref17"><label>17</label><mixed-citation publication-type="other" xlink:type="simple">S. Jager, D. Mack, H. Rohde, M. A. Horstkotte and J. K.-M. Knobloch, “Disintegration of Staphylococcus epidermidis Biofilms under Glucose-Limiting Conditions Depends on the Activity of the Alternative Sigma Factor Sigma B,” Applied and Environmental Microbiology, Vol. 71, No. 9, 2005, pp. 5577-5581.  
doi:10.1128/AEM.71.9.5577-5581.2005 </mixed-citation></ref><ref id="scirp.25866-ref18"><label>18</label><mixed-citation publication-type="other" xlink:type="simple">G. D. Christensen, W. A. Simpson, J. J. Younger, L. M. Baddour, F. F. Barrett, D. M. Melton and E. H. Beachey, “Adherence of Coagulase-Negative Staphylococci to Plastic Tissue Culture Plates: A Quantitative Model for the Adherence of Staphylococci to Medical Devices,” Journal of Clinical Microbiology, Vol. 22, No. 6, 1985, pp. 996-1006.</mixed-citation></ref><ref id="scirp.25866-ref19"><label>19</label><mixed-citation publication-type="other" xlink:type="simple">J. B. Kaplan, C. Ragunath, K. Velliyagounder, D. H. Fine and N. Ramasubbu, “Enzymatic Detachment of Staphylococcus epidermidis Biofilms,” Antimicrobial Agents and Chemotherapy, Vol. 48, No. 7, 2004, pp. 2633-2636.  
doi:10.1128/AAC.48.7.2633-2636.2004 </mixed-citation></ref><ref id="scirp.25866-ref20"><label>20</label><mixed-citation publication-type="other" xlink:type="simple">E. Enghofer and H. Kress, “An Evaluation of the Morgan- Elson Assay for 2-Amino-2-Deoxy Sugars,” Carbohydrates Research, Vol. 76, 1979, pp. 233-238.  
doi:10.1016/0008-6215(79)80022-1 </mixed-citation></ref><ref id="scirp.25866-ref21"><label>21</label><mixed-citation publication-type="other" xlink:type="simple">S. Jager, B. Jonas, D. Pfanzelt, M. A. Horstkotte, H. Rohde, D. Mack and J. K. Knobloch, “Regulation of Biofilm Formation by Sigma B Is a Common Mechanism in Staphylococcus epidermidis and Is Not Mediated by Transcriptional Regulation of Sar A,” The International Journal of Artificial Organs, Vol. 32, No. 9, 2009, pp. 584-591.</mixed-citation></ref></ref-list></back></article>